激素敏感转移性前列腺癌预后因素分析

Prognostic factors in hormone sensitive metastatic prostate cancer

目的 探寻影响激素敏感转移性前列腺癌进展为去势抵抗性前列腺癌（CRPC）的预测因子。方法纳入北京积水潭医院2006年6月-2014年6月收治的50例激素敏感转移性前列腺癌患者。收集此50例患者的临床和病理资料,并对这些患者进行规律门诊和住院随访。将临床病理资料以及患者的预后数据采用SPSS16.0统计软件进行分析。生存函数分析运用Kaplan-Meier法,单因素和多因素分析运用Cox回归,并采用Log-rank法进行显著性检验。结果 末次随访时间为2014年10月31日,中位随访时间34（9~83）个月。随访期间有17例患者进展为CRPC。患者内分泌治疗无进展生存时间曲线结果显示：患者的中位无进展生存时间为34（9~83）个月,1、2及3年无进展生存率分别为84%、58%及42%。单因素和多因素分析结果显示：Gleason评分（P=0.003）、基线PSA值（P=0.049）、碱性磷酸酶（P=0.021）、四肢骨转移（P=0.005）、内脏转移（P=0.006）为激素敏感转移性前列腺癌进展为CRPC的独立预后因素。结论 Gleason评分、基线PSA、碱性磷酸酶、四肢骨转移及内脏转移为激素敏感转移性前列腺癌进展为CRPC的独立预测因子。

【Objective】To explore the prognostic factors affecting the progression of hormone sensitive metastatic prostate cancer to castration-resistant prostate cancer（CRPC）.【Methods】 A total of 50 cases of hormone sensitive metastatic prostate cancers were treated with androgen deprivation therapy（ADT） in Beijing Jishuitan Hospital from June 2006 to June 2014. Their clinical and pathological data were retrospectively collected and they were followed up regularly in the clinic or in the hospital. The statistic software SPSS 16.0 was used for analyses in this stud. Cumulative survival plots were made using the Kaplan-Meier method and were compared with the log rank test. Cox regression was used for univariate and multivariate analysis. Log-rank method was used for the significance test.【Results】The last follow-up date was 31 th October 2014 and the median follow-up time was 34（9~83） months.There were 17 patients who progressed to CRPC during the treatment of ADT. The median survival time of ADT without progression was 34（9~83） months, and the one-year, two-year, three-year progression-free survival rates were 84%, 58%, 42%, respectively. The univariate and multivariate analyses indicated that the Gleason score（P =0.003）, baseline PSA（P =0.049）, alkaline phosphatase at start of treatment（P =0.021）, appendicular bone metastases（P =0.005） and visceral metastases（P =0.006） were independent prognostic factors in the progression of hormone sensitive metastatic prostate cancer to CRPC. 【Conclusions】Baseline PSA, Gleason score, alkaline phosphatase at start of treatment, appendicular bone metastases and visceral metastases were independent prognostic factors affecting the progression of hormone sensitive metastatic prostate cancer to CRPC.